The Role of C-reactive Protein in Diagnosis of Acute Complicated Appendicitis: A Diagnostic Accuracy Study

Introduction: Acute appendicitis is one of the most common emergencies of general surgery. Contrary to simple appendicitis, the complicated cases are associated with higher morbidity and mortality. Except for pathology, no accurate diagnostic test has been found to identify complicated cases. Objective: Here in, we aim to evaluate the serum C-Reactive Protein (CRP) level in both acute simple and complicated appendicitis. Methods: In this diagnostic accuracy study, 199 patients with acute appendicitis were enrolled. The serum CRP level was evaluated in patients. Post-operatively, the patients were divided into simple and complicated appendicitis based on histopathological examination. Eventually, analysis of the CRP level and type of appendicitis was performed. Results: Fifty-three patients were categorized into complicated appendicitis and 146 patients into simple appendicitis. The median of CRP was significantly higher in the complicated group. Additionally, the optimal cutoff point was as follows: [65.0 (25.0) vs 25.0 (51.0); P-value< 0.001]. The optimal cutoff point for CRP was more than 42 with 81.1% sensitivity (95% CI: 68.0 to 90.6), and 67.8% specificity (95% CI: 59.6 to 75.3). The positive (PPV) and negative predictive values (NPV), based on the prevalence of complicated appendicitis (26.6%) for optimal cutoff point, were 47.8% (95% CI: 37.1 to 58.6) and 90.8% (95% CI: 83.8 to 95.5). Conclusion: Our study revealed that evaluation of serum CRP levels could be useful and beneficial in the diagnosis of acute complicated appendicitis

The characterization of oxaliplatin-induced peripheral neuropathy using electromyography in gastrointestinal cancer patients

Oxaliplatin-induced peripheral neuropathy (OIPN) is a common dose-dependent chemotherapy complication in gastrointestinal cancer (GIC). This side effect may restrict therapeutic dose elevation of oxaliplatin. Here, OIPN frequency and determinants of neuropathy appearance in oxaliplatin-treated GIC patients. A total of 102 GIC patients who underwent chemotherapy with fluorouracil, folinic acid and oxaliplatin (FOLFOX4) regimen participated in this longitudinal study. Electromyography (EMG) was accomplished for ulnar, radial, sural, peroneal nerves and superficial peroneal nerve (SPN) before, 3, and 6 months after treatment. National Cancer Institute-Common Toxicity Criteria V.3 and clinical version of the Total Neuropathy Score were used for the neuropathy diagnosis at six months after treatment onset. Of all entered patients, twelve people discontinued this study, and five patients passed away. About 85 patients remained three and six months after chemotherapy onset. Approximately 95% of patients three months after chemotherapy demonstrated OIPN manifestations. Finally, data for 81 patients having neuropathy were analyzed. Mean age of patient 64.0±10.9 years. There were about 3.7%, 30.9%, 63% grade III, II, I of neuropathy, respectively. Interestingly, a significant decrease in action potential (AP) amplitude of SPN, sural and radial nerves but not ulnar and peroneal was observed after treatment onset. However, only the ulnar nerve indicated a substantial deceleration of nerve conduction. Age, sex, weight, past medical diseases, smoking and acute neuropathy were not significantly associated with OIPN. The occurrence of OIPN is detectable by electrophysiological changes of SPN, radial, and sural nerves at three and six months after starting chemotherapy with the FOLFOX4 regimen

Burning mouth syndrome: A comparative cross-sectional study

Background and Aim: Burning mouth syndrome (BMS) may be defined as a burning sensation in the oral mucosa usually unaccompanied by clinical signs. Multiple conditions have been attributed to a burning sensation. The aim of this study was to determine the role of age and sex in BMS. Materials and Methods: A total of 195 consecutive patients with BMS and 95 healthy patients without burning sensation were recruited in this study. Patients with BMS had experienced oral, burning sensations for at least 6 months without oral clinical signs, and with a normal blood count. Multiple logistic regression analyses were utilized to define the main predictors. Results: Menopause, candidiasis, psychological disorders, job status, denture, and dry mouth were significantly frequent in BMS patients. Multivariate logistic regression indicated age (odds ratio (OR) =1.12, 95% confidence interval (CI): 1.08–1.15, P < 0.0001) and sex (OR = 3.14, 95% CI: 1.4–6.7, P < 0.002) significantly increase the odds of BMS. Psychological disorders (OR = 3.39, 95% CI: 1.2–9.5, P < 0.02) and candidiasis remain as predictive factors. Ultimately, age was defined as a critical predictor. Moreover, we can therefore predict that a 60-year-old woman with psychological disorders is 25 times more likely to suffer from BMS than a man 10 years younger who has no psychological disorder. Conclusion: Age and sex were the main predictors in BMS. Psychological disorders and candidiasis were significantly associated with the occurrence of BMS

Reproducibility of Optical Coherence Tomography Retinal Nerve Fiber Layer Thickness Measurements Before and After Pupil Dilation

Purpose: To evaluate the intra- and interobserver reproducibility of peripapillary retinal nerve fiber layer (RNFL) thickness measurements before and after pupil dilation using spectral-domain optical coherence tomography (SD-OCT). Methods: In this observational case series, 44 eyes of 44 healthy subjects were scanned by two trained operators on the same day, using Cirrus SD-OCT (Carl Zeiss Meditec, Dublin, CA, USA). Three scans were obtained before and after pupil dilation by each operator. Mean ± standard deviation (SD) and coefficient of variation (CV) were used for description of results and variation of measurements respectively. Intraclass correlation coefficients (ICC) and Bland-Altman plots were used to evaluate validation and limits of agreement. Results: Overall, 23 female and 21 male subjects with mean age of 36.9±8.8 (range, 20 to 50) years were enrolled. Mean RNFL thickness before pupil dilation was 92.6±7.2 (CV, 7.8%) and 92.4±6.8 (CV, 7.4%) μm by operator one and two, respectively. After pupil dilation, mean RNFL thickness was 92.7±7.9 (CV, 8.5%) and 92.0±7.5 (CV=8.2%) μm by observer one and two, respectively. ICCs ranged from 0.900 to 0.996. Mean absolute error of the two operators was less than 4.1μm. There were no significant differences in quadrant thicknesses before and after dilation. Interestingly, mean signal strength was not significantly affected by pupil dilation. Conclusion: In normal subjects with clear media, peripapillary RNFL thickness measurements using Cirrus SD-OCT have high inter- and intraobserver reproducibility before and after pupil dilation. Pupil dilation may not be necessary in all subjects to obtain reproducible RNFL thickness measurements